Sunday, March 1, 2020

Anxiety Disorders are a
frequent co-occurring (comorbid) problem for children and youth with autism spectrum disorder (ASD).
Although prevalence rates vary from 11% to 84%, most studies indicate that
approximately one-half of children with ASD meet criteria for at least one
anxiety disorder. Of all types of anxiety disorders, specific phobia is
the most common, with prevalence estimates ranging from 31% to 64%. In contrast,
estimates of phobias in children in the general population range from 5% to
18%.

Unusual fears have long
been recognized as a feature of autism. In fact, 70 years ago, Leo Kanner wrote
in his initial account of autism that “loud noises and moving objects” are
“reacted to with horror” and things like “tricycles, swings, elevators, vacuum
cleaners, running water, gas burners, mechanical toys, egg beaters, even the
wind could on occasions bring about a major panic.” We now know that children
with autism perceive, experience, and respond to the world very differently
than children without autism. Experiences that may be tolerable for most typical
children might be frightening, disturbing, or irritating for a child with ASD.
Children with autism may also be unresponsive to other experiences (e.g.,
insensitive to pain), may not show stranger or separation anxiety, and may be seemingly
unaware of obvious dangers (e.g., running into traffic).

Research

Previous research
examining the types and frequencies of fears in children with autism have found
odd and intense fears in approximately 40% of children with autism, whereas
unusual fears were present in only 0–5% of children without autism, including
children with a learning disability, language disorder, ADHD, intellectual
disability, and typical development. Studies also indicate that while some of
the most common fears for children with autism and typical development overlap,
children with autism have frequent fears that were not amongst the most frequently
reported for typical children. These include fear of thunderstorms, large crowds,
and closed spaces.

A large scale study
reported in Research in Autism Spectrum Disordersinvestigated unusual
fears in a sample of 1033 children ages 1-16 with autism. The purpose of the
study was to categorize and determine specific types of unusual fears in children
with autism as well as identify variables related to the presence or absence of
these fears. Unusual fears were reported in 421 (40.8%) of the 1033 children
with autism. A total of 487 unusual fears were reported, representing 92 different
fears. The most common unusual fears in three or more children with were toilets, elevators, vacuum cleaners, thunderstorms, heights, and visual media(characters in or segments of movies, television shows, commercials, or computer games). Many children also had common childhood fears and phobias
(including fear of dogs, bugs, spiders, snakes, the dark, doctors, barbers,
monsters, people in costumes, mechanical toys, sleeping alone, fire, and swimming),
which increased the overall proportion of children with autism who had intense
fears and phobias to more than 50%.

§Visual
media (Characters in or
segments of movies, television shows, commercials, computer games)

Types and Frequency of
Unusual Fears

Unusual fears reported by
parents fell into two categories: (1) uncommon fears not typically reported in
children in the general population or in children with specific phobias and (2)
fears that have been reported in studies of children without autism but which
were considered unusual by parents because of their intensity, obsessiveness,
irrationality, or interference with functioning. Of the total number reported, the
most common unusual fears in three or more children with autism were:

§Toilets

§Elevators

§Vacuum
cleaners

§Thunderstorms

§Tornadoes

§Heights

§Visual
media

Associated variables

Children with and without
unusual fears did not differ in age, IQ level, mental age, autism severity,
race or parent occupation. Of all the demographic variables, only female gender
was associated with the presence or absence of unusual fears. More girls had
unusual fears (48.8%) than did boys (39.1%). This is consistent with the
earlier studies indicating that girls with autism had more fears than boys and with
general population studies showing that girls had more fears and higher fear survey
scores than boys. The finding that children with and without unusual fears did
not differ in age suggests that unlike most typical children, those with autism
may not outgrow unusual fears. Likewise, the findings regarding autism severity
and parent occupation suggest that the presence of unusual and intense fears
may be present across SES and the entire autism spectrum. The authors note that
the lack of demographic differences in the study may suggest a neurobiological
basis for fears overriding developmental and environmental influences.

Implications

Research suggests that it
is critical to assess for unusual and intense fears in children with ASD because
they are common and can interfere significantly with functioning.
Specific fears and phobias have been cited as frequent anxiety triggers/stressors
for children with ASD. The impact of anxiety includes personal distress in children,
parents, and siblings, increase in challenging behavior and stereotyped
behaviors, restriction of activities/opportunities and negative impact on quality of life for child and
family. For example, children with autism may avoid necessary life
situations (e.g., refusing to go to school because there may be a fire drill)
or be in a constant state of anxiety and unable to function optimally because
of their fears.

Identification of specific fears and phobias can
help educators and interventionists improve programs and services for children on the autism spectrum. This information may be especially useful for clinicians,
particularly those utilizing CBT as a treatment approach for children and youth
with ASD. There is
evidence to suggest that the interventions used to treat intense fears and phobias
in children without autism (exposure, desensitization, modeling, shaping, and reinforcement)
might also be effective for children who have autism. Lastly, further research
is needed to investigate why some specific unusual fears are common to autism
but not the general population. As more individuals with ASD communicate about
their fears and reasons for their idiosyncrasies, we may come to a better understanding
of autism and its symptoms.

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